Leukoencephalopathy in Patients with Brain Metastases Who Received Radiosurgery With or Without Whole Brain Radiotherapy

Author:

Liu Chan-Wei1,Yang Huai-Che1,Chiang Chi-Lu1,Shen Chia-I1,Wu Hsiu-Mei1,Luo Yung-Hung1,Hu Yong-Sin1,Lin Chung-Jung1,Chung Wen-Yuh1,Shiau Cheng-Ying1,Guo Wan-Yuo1,Pan Hung-Chi2,Lee Cheng-Chia1

Affiliation:

1. Taipei Veterans General Hospital

2. Taipei Medical University

Abstract

Abstract BackgroundWhole brain radiation therapy (WBRT) for brain metastases (BMs) is a common cause of radiation-induced leukoencephalopathy; however the safety of alternative stereotactic radiosurgery (SRS) remains unclear. This study examined the incidence of leukoencephalopathy in patients treated with SRS alone versus WBRT plus SRS for BMs with a focus on the relationship between prognostic factors and leukoencephalopathy.MethodsAnalysis was performed between 2002 and 2021. The total enrollment was 993 patients with the distribution: WBRT plus SRS (n=291) and SRS only (n=702). Leukoencephalopathy was graded from 0 to 3 for changes in white matter indicated by the MRI after WBRT or SRS. Patient characteristics and SRS dosimetric parameters were reviewed to identify factors that contributed to the incidence of leukoencephalopathy or overall survival.ResultsThe incidence of leukoencephalopathy was consistently higher in WBRT plus SRS group than in SRS alone group (p<0.001). Leukoencephalopathy was also associated with a larger total tumor volume (≧28cm3; p=0.028) and age (>77 years; p=0.025). Nonetheless, the SRS integral dose to skull in the subgroup of WBRT plus SRS treatment was not demonstrated significance in development of leukoencephalopathy (p=0.986 for integral dose 1-2J, p=0.776 for integral dose>2J).ConclusionsThis study revealed that SRS is safe for oligo-BMs in terms of leukoencephalopathy development. Patient age and total tumor volume were identified as important factors in assessing the development of leukoencephalopathy. The additional of SRS (even at an integral dose>2J) did not increase the incidence of leukoencephalopathy.

Publisher

Research Square Platform LLC

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